This article describes the development and evaluation of a Nursing Assistant Communication Skills Program (NACSP). NACSP was designed to help nursing assistants (NAs) interact more effectively with nursing home residents with moderate and severe dementia. In two skilled-care nursing homes, NAs in four units were randomly assigned by unit to NACSP or to a wait-list control condition (UC) and were assessed at baseline, 3 months, and 6 months. NACSP resulted in improvement in the well-being of nursing home residents being cared for by NAs who had received the NACSP training. It was also found that NACSP resulted in greater knowledge of caregiving responses and reduced turnover rates among NAs, but the program had no impact on their knowledge of dementia. To disseminate the NACSP program, a leader manual, an accompanying training videotape, and a workbook for participants were developed.

The purpose of this survey was to describe nursing home social services staff roles and perceptions related to end-of-life medical decision making for nursing home residents in endstage dementia. Using a self-designed questionnaire, 138 nursing home social services staff from across New York State answered questions about advance directives, medical interventions, and comfort levels with withholding and withdrawing of treatment. Results showed a high degree of involvement in advance directive discussions, problems in the implementation of advance directives, and wide variation in comfort levels with treatment issues. Results of this study indicate areas of need for further research and training of nursing home social services staff.

Little empirical information exists on nursing home social worker's involvement in advance care planning and end-of-life decision- making with nursing home residents and their family members. The purpose of this exploratory study was twofold: (1) to identify the frequency of skills associated with advance care planning that social workers use, and (2) to explore the factor structure of the scale used in the study. Results from 138 nursing home social worker respondents from New York State showed high frequency of advance directive discussions, care planning, and conflict resolution with families. The instrument factors clustered around administrative duties, and grief issues. There was substantial interest in continuing education in grief counseling with families.

This article discusses the literature supporting the limited use of tube feeding, antibiotics, and hospital transfers of nursing home residents with end-stage dementia. This article also presents the findings of a study that queried 138 nursing home social service staff members in New York State regarding positions taken by key medical decision makers regarding tube feeding, antibiotic use, and hospitalization of nursing home residents with end-stage dementia. Results are discussed in the context of positions taken by experts in palliative and dementia care. According to social service staff perceptions, the majority of these key decision-makers (e.g., administrators, directors of nursing, and medical directors) take positions inconsistent with palliative care experts. Instead, a majority of them were perceived as more likely to encourage tube feeding, antibiotics, and hospitalization of nursing home residents with end-stage dementia. These findings indicate a strong need for educating administrative staff in state-of-the-art care of residents with end-stage dementia.

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